Admission Self-Care and Mobility Scores Predict Length of Stay and Discharge Outcomes in Stroke Rehabilitation

Background and/or Objectives: This investigation determined which admission self-care and mobility Inpatient Rehabilitation Facility-Patient Assessment Instrument (PAI-IRF) GG functional assessment best predicted post-acute length of stay (LOS) and home discharge in patients undergoing inpatient stroke rehabilitation.

Design: Retrospective cohort analysis.

Setting : Quaternary care inpatient rehabilitation.

Participants : Patients admitted for stroke rehabilitation (N=603, 7% using manual wheelchair for locomotion, 86.4% and 87.9% were independent for prior selfcare and indoor mobility, respectively). Discharge dispositions were grouped by independence and care needs: Group 1 (More Independent): Home (74.8%, N=451), Home Health (11.9%, N=72). Group 2 (Needs Institutional Care): Short-term Hospital, SNF, Hospice, Not Listed (13.3%, N=80).

Interventions: NA

Main Outcome Measures: Discharge disposition. LOS (was defined as the national average for stroke post-acute care [14 days] and prolonged >14 days); Functional GG self-care and mobility items (scored 1[maximal dependence], 6 [independent]). Receiver operating curves (ROC) were produced using admission GG scores to predict the discharge disposition and average LOS.

Results: Model 1 (mobility GG items) “sit-to-stand performance” score was predictive of LOS (AUC = 0.714, SE = 0.023, 95% CI: 0.670–0.758). A score >3 indicated a 71% chance of staying in the IRF for 14 days. Model 2 (self-care GG) “dressing the lower body” score was predictive of LOS (AUC = 0.740, SE = 0.021, 95% CI: 0.698–0.781). A score >2 indicated a 74% chance of staying in the IRF for 14 days. Model 3 (self-care GG) “dressing the lower body” >2 predicted a higher likelihood of discharge to home (AUC of 0.752, SE = 0.028, 95% CI: 0.697–0.807).

Conclusions: Assessing lower body dressing ability and sit to stand performance at admission may provide valuable insight for identifying patients who can successfully discharge by the national average. Lower body dressing ability was a predictor of discharge to home. Early interventions targeting these two functional factors could potentially guide therapeutic activities and help predict discharge outcomes.